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Spinal Empyema & Abscesses from Foreign Bodies

Clinician's Brief (Capsule)

Neurology

|February 2015

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This case report represents the first description of atlantoaxial epidural abscess seen in a dog. A 2-year-old female Lucerne hound presented with a 1-week history of progressive neck pain, inappetence, apathy, and elevated rectal temperature. MRI revealed changes consistent with an abscessed foreign body at the level of the first and second cervical vertebrae. A migration tract at the level of C4 originating from the skin was also identified on MRI. Presence of a 1-cm structure was confirmed on ultrasonographic imaging. CSF analysis was performed and found to be unremarkable. A dorsolateral atlantoaxial surgical approach and desmotomy revealed the abscess cavity and pus, which was submitted for bacterial culture. A 4-cm grass awn was identified and removed.

Spinal empyema (purulent discharge in a natural cavity without a capsule) or abscess (with capsule formation) has been reported only rarely in dogs; there are only 2 case reports of grass awn-induced lesions in the thoracic and lumbar spine. A third case report described a foreign body-induced lesion in the C3–C4 spine of a cat. Clinical signs in these cases are nonspecific and neurologic deficits may be delayed. Spinal epidural abscess may lead to irreversible neurologic deficits or life-threatening sepsis. Rapid surgical decompression and appropriate antimicrobial therapy are crucial to treatment and successful outcome.

Commentary

This case report from Switzerland highlighted the importance of early advanced imaging when treating severe spinal pain. Often empirical antibiotic treatment will help in these cases, but the clinical signs usually recur following cessation of the medication unless the foreign material is removed. Consideration could have been given to closed suction drain placement at the time of surgery to allow for ongoing external drainage. The 6-week course of antibiotic regimen is typical, but the question can be asked: Can it be treated successfully with a shorter course?—Jonathan Miller, DVM, MS, DACVS

References

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